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Re: Combined universal ultrasound screening for developmental dysplasia of the hip and neonatal hearing

Dear Editor

We read with interest the recent articles of Dezateux et al.[1] and Brown et al.[2] on screening for developmental dysplasia of the hip.

Our local child health promotion group proposed an innovative service for universal neonatal hearing screening and universal ultrasound hip screening of all our 4200 babies delivered in our area. This would be a mobile community based service, provided in heath centres located within the four distinct localities and easily accessible for families without a car. Children would be invited for a combined appointment for both universal neonatal hearing and hip ultrasound screening to be undertaken at around 4 weeks of age.

The children would continue to have a neonatal clinical examination at birth, including Ortolani and Barlow tests. A combined appointment would lead to less inconvenience to parents and consequently higher uptake rates as well as providing for the possibility of reduced staff travelling costs. Information would be given to the parents during their antenatal visit and the appointment would be arranged shortly after birth via Labour Ward and recorded in the mother’s maternity notes and the parent held child health record. Parents would be informed with posters at general practitioners surgeries and the hospital antenatal clinics.

We estimated the cost of our proposed combined screening of hearing and developmental hip dysplasia to be less than £100,000 per year, described in detail in table 1.

Table 1 Estimated cost for combined universal hearing and ultrasound hip screening for 4200 deliveries per year

If this cost is projected to 100,000 deliveries, the proposed combined screening would cost less than £2,381,000, that works out less expensive than £4,394,515 that Brown et al.[2] described in their study for only the universal ultrasound hip screening. We hope that the high non-attendance in community based clinics [3] would not affect negatively our proposed service, although we calculated in our estimation an average of 20% of non-attendance to the first appointment.

References

(1) Dezateux C, Brown J, Arthur R, et al. Performance, treatment pathways, and effects of alternative policy options for screening for developmental dysplasia of the hip in the United Kinfdom. Arch Dis Child 2003;88:735-59.

(2) Brown J, Dezateux C, Karnon J, et al. Efficiency of alternative policy options for screening for developmental dysplasia of the hip in the United Kingdom. Arch Dis Child 2003;88:760-766.

(3) Sharp DJ, Hamilton W. Non-attendance at general practices and outpatient clinics. BMJ 2001;323:1081-2.